CONTENTS
HIGHLIGHTS
December 1995 |
After IUD insertion, uterine contractions can push the device downward, causing partial or complete expulsion. Expulsion rates vary from less than one to more than 7 per 100 women in the first year of use (see Table 1). Most expulsions occur in the first year and especially the first three months after insertion (173, 314, 368, 385). Because undetected partial or complete expulsion can lead to unplanned pregnancy, IUD users should know how to check for the IUD strings to make sure that the device is still in place (see sidebar, Important Information About the TCu-380A IUD). Several factors influence the chances of expulsion. Younger women and women who have never been pregnant or have never had children are more likely to expel their IUDs (333, 334, 340, 383, 437, 444, 516, 546, 583). A recent case- control study based on data from an international clinical trial also found that women who had painful menstruation or abnormally large menstrual flows were more likely to expel copper-T IUDs (569). Correct insertion, with the IUD placed up to the fundus, is thought to reduce the chances of expulsion (60, 71) (see Insertion Technique, Chapter 3.1). |